| NPI | 1366172652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013912A) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00205119) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-11-22 |